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Case Report: First Reported Case of Disease: Peliosis Hepatis as Cardinal Symptom of Hodgkin's Lymphoma

^aDepartment of Internal Medicine I, ^bDepartment of Internal Medicine III, ^cDepartment of Pathology, ^dDepartment of Radiology, and ^eDepartment of Internal Medicine II, University Medical Centre Ulm, Centre for Internal Medicine, Ulm, Germany

Key Words. Hodgkin's disease • Lymphoma • Minilaparoscopy • Peliosis hepatis • Liver disease

Correspondence: Correspondence: Alexander Kleger, M.D., Ph.D., Department of Internal Medicine I, University Medical Centre Ulm, Centre for Internal Medicine, Albert Einstein Allee 23, 89081 Ulm, Germany. Telephone: 49-731-500-44728; Fax: 49-731-500-44665; e-mail: alexander.kleger{at}uni-ulm.de

Received September 10, 2009; accepted for publication October 7, 2009.

Alexander Kleger: None; Martin Bommer: None; Markus Kunze: None; Jochen Klaus: None; Frank Leithaeuser: None; Martin Wegener: None; Guido Adler: None; Nektarios Dikopoulos: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors or independent peer reviewers.

We present the case of a 25-year-old woman with a history of weakness, weight loss, anemia, and elevated liver enzymes. Outpatient diagnostic evaluation, including abdominal ultrasound and endoscopies, revealed no conclusive explanation for the clinical picture and the patient was admitted to our clinic. Because of the hepatosplenomegaly together with the elevated liver enzymes, one of our differential diagnoses was that of liver disease. To clarify this, we performed a minilaparoscopy, which showed multiple diffuse distributed spots of livid color without clear margins distributed all over both liver lobes. A biopsy taken from these areas revealed the diagnosis of peliosis hepatis with irregular and diffusely enlarged hepatic sinusoids with an irregular structure. Peliosis hepatis is associated with numerous infectious and neoplastic diseases, but also occurs as a result of toxic liver damage. Further evaluation of our patient with an x-ray and a computed tomography (CT) scan revealed a mediastinal mass and a CT-guided biopsy showed classical Hodgkin's lymphoma. After completing further screening, a definitive diagnosis of Hodgkin's lymphoma stage II/N/B (Ann-Arbor) was established and chemotherapy according to the German Hodgkin's study group protocol with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (the BEACOPP regimen) was initiated. After the first chemotherapy cycle, the patient's symptoms and laboratory values improved rapidly. Taken together, we present the case of a patient with peliosis hepatis as an uncommon manifestation of Hodgkin's lymphoma. Despite an extensive literature search, we could not find any case of peliosis hepatis associated with a de novo diagnosis of classical Hodgkin's disease.